Now Prepay Retailer Application Form

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Store Information - Step 1 of 3

Contact for Store

First

Last

like Birth applicants

Type of Business

Store Name (Doing business as)

Company Legal Name

(Exactly as it appears on your business license)

Store Phone Number

Store Email Address

Store Address (Please include suite or unit number if required)

Address Line 1

City

State / Province / Region

Postal Code

Country

HST/GST Number

Do you have a PST/QST Number? (For applicants in BC, SK, MB & QC)

Please provide your PST/QST Number

By checking this box, I agree to add gift cards to my store and accept the $1.50 weekly fee.

Please choose a display for your Gift Cards

Save and Resume Later

Owner's Name

First

Last

Owner's Mobile Phone Number

Owner's Email

(Please note that this email will be used to sign the retailer agreement through Adobe Sign)

Owner's Date of Birth

Owner's Home Address

Address Line 1

City

State / Province / Region

Postal Code

Country

(Please provide the owner's residential address)

Save and Resume Later

Store Billing Address

Billing Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Please confirm the date after which we can proceed with shipping, or the date you can receive shipments at your location. Once confirmed, we will arrange delivery to your store address.

Kindly note that if the shipment is refused or returned, non-refundable courier fees will apply.

Please provide any additional notes or information you'd like us to include as we set up your account.

Now Prepay Retailer Application Form

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